What to do if you are paying too much to call your NHS GP

If your GP is using a 0844 or 0845 telephone number and this costs you more than the cost of an equivalent call to a geographic number, then the practice is in breach of its NHS contract.

(In theory, there may be circumstances in which it is unable to migrate to the equivalent 034 number, but I have seen no evidence of any such case.)

My suggestions for actions you may wish to take follow. Please contact me at any point for detailed advice, support and assistance.

Update - 24 February 2012

This briefing was published before I became aware of the Further Guidance issued by the Department of Health, as covered by this item. My Suggestions are unchanged, as this Guidance does not in any way change the position. The only possibility is that more PCTs and practices will consider complying, if they had previously failed to take the trouble to understand the terms of contract revisions.

The efforts of Which?

I support the efforts of Which? to use its position to collect a large amount of evidence so as to draw attention to this issue. I do not however believe that the failure of the government to take action has got anything whatsoever to do with it being unaware of what is happening.

My Suggestions

♦	Remind the practice that it is under a contractual duty to "ensure that, having regard to the arrangement as a whole, persons will not pay any more to [call the practice] than they would to make equivalent calls to a geographical number".
	ο	Ask if you are considered as being a person who calls the practice - part of the arrangement as a whole.
	ο	Ask for a copy of any confirmation of compliance provided to the Primary Care Trust, which administers the contract. This may cover the relative cost of calling or the inability of the practice to migrate to the equivalent 034 number.
	ο	Let the evidence speak for itself. It is the duty of the Primary Care Trust to enforce the terms of the NHS contract; this has nothing to do with any contractual relationship between you and the practice. Not yet anyway!
♦	Speak to the Primary Care Trust PALS department and ask if they are enforcing the requirement for GPs not to use telephone numbers that cost callers more than the cost of an equivalent call to a geographic number. You will probably need to continue the exchanges in writing.
	Many PCTs have chosen to adopt their own policy of tolerance, rather than enforcing the terms of the contractual requirements.
	ο	If the practice is deemed to be compliant with the PCT policy, ask for a copy of this policy and the evidence provided by the practice to demonstrate compliance with that policy.
	ο	If the PCT indicates that it is enforcing the terms of the contract, ask why this requirement has not been enforced in the case of your GP, as the deadline for compliance was 1 April 2011. Offer your assistance.
♦	Contact your local media to advise that the NHS in your area has been suspended as a universal service and that your rights to access services without charge are not being enforced. They will be keen to know of:
	ο	The reality of the situation for you
	ο	The false evidence of compliance provided by the surgery
	ο	The improper policy being followed by the Primary Care Trust
♦	Raise a complaint with the Health Service Ombudsman against the accountable officer for the Primary Care Trust (the Chief Executive of the PCT "Cluster") for failing to discharge their statutory duty to have regard to the NHS Constitution in exercising their NHS functions.
	ο	The stated policy of the Trust should represent adequate evidence of this failure in respect of:
	ο	The right to access services without charge.
	ο	Failure to apply the principle that NHS services are available to all on equal terms.
♦	Approach your MP to see if they are prepared to support you in presenting a formal complaint to the Parliamentary Ombudsman regarding the failure by the Department of Health to ensure enforcement of the contractual requirements. This failure is most clearly demonstrated by:
	ο	Failure to recognise evidence of breaches, as declared by the Minister in parliament.
	ο	Failure to contradict false statements about the Department approving use of expensive numbers when provided by a certain company. (False allegations about the Department's position have been accepted by many PCTs.)
	ο	Failure to respond to requests for clear guidance from PCTs. Further guidance has been promised to, and expected by, PCTs since April of 2011 - but none has been issued.

I recognise that many will be reluctant to follow all of these steps. I have myself approached every PCT in England over the last two years with briefings and urging them to respect the principles of the NHS. I have also briefed every MP with constituents who are affected.

My own GP is happily one of the many who support the principles of the NHS. The head of practice has confirmed to me that he "would not touch of on those expensive numbers with a bargepole".

Why this is necessary

The current UK government clearly believes that, like its predecessor, it is responding to public demand in seeking to replace our beloved National Health Service, funded by taxation, with an alternative system which will, in time, be largely funded by insurance and cash payments to GPs and other service providers. It can however only do so for England, unless it reverses provisions of the devolution settlements.

It is for those of us who do not wish for this to make it plain that we are not prepared to accept the principles of the NHS being disregarded, whilst they remain in force, and even before the necessary provisions have been placed before parliament. It is important for campaigners to understand that the current Bill does not itself replace the NHS. It simply removes the structures that enable it to work as a National service and replaces them with alternatives suited to a consumerist alternative. Rather than putting in measures to address the inevitable growth in public spending on healthcare, it opens the door to unlimited spending - in the sure knowledge that this cannot come from the public purse.

Tolerance of a few pence or a few pounds cost to provide a subsidy of a few pence on every telephone call is a very modest breach of the principles of the NHS. A clear and determined failure to respond to the challenge to address this abuse cannot but indicate that these principles mean nothing. What is perhaps worse is that they are being disregarded, whilst being defended with worthless words.